Assertiveness Questionnaire
By: Bowman, Sarah
Instance of: Assertiveness (Old Version)
To Print this page: Click Here
For help with printing (margins, paper size, etc): Click Here
Assertiveness is expressing your wants, needs, and thoughts, even when it’s difficult, while respecting others.
1. Express Myself: Are you expressing your feelings clearly? Are you creating and adhering to your boundaries? Strategies include identify communication types, find my feelings, voice my feelings, speak my mind and be kind, respect my boundaries, do my part, and predict outcomes.
2. Respect Others: Are you considering the perspectives of others? Are you communicating respectfully? Strategies include show empathy, listen and summarize, and show respect without words.
The graph provides average ratings for all items within a component, and the table displays the number of students that selected each rating for individual items. In the table, some items, such as “When an argument is over, I often wish I would have said what was really on my mind,” are reverse scored. Selecting a rating of “1—Not Very Like Me” means that students are demonstrating assertiveness, whereas selecting a rating of “5—Very Like Me” means that they may need to focus on assertiveness.
The quiz section shows the correct answer to each knowledge question and the percentage of students that selected the correct answer. Guide students to reflect on the results of this questionnaire and knowledge test to identify ways to continue expanding their learning and practice of assertiveness. Resources for teaching assertiveness are available at www.cccframework.org
| NOT Like Me |
VERY Like Me |
|||||||
| Question | Topic | Reversed? | Reverse Corrected Average | #1 Cnt | #2 Cnt | #3 Cnt | #4 Cnt | #5 Cnt |
| 1. I stand up to my friends if they are doing something I don't feel comfortable doing. | Boundaries | NO | 3.3 | 1 | 1 | 5 | 3 | 2 |
| 2. To be honest, people often take advantage of me. | Boundaries | YES | 2.4 | 1 | 1 | 3 | 4 | 3 |
| 3. I have personal boundaries like 'no cheating off my homework' or 'I won't let friends borrow money" | Boundaries | NO | 2.8 | 1 | 3 | 6 | 1 | 1 |
| 4. If someone was upsetting me, I would keep my feelings to myself rather than politely remove myself from the situation. | Boundaries | YES | 2.8 | 1 | 1 | 5 | 5 | 0 |
| 5. I often have a hard time saying 'No" | Express Myself | YES | 2.3 | 2 | 0 | 1 | 5 | 4 |
| 6. I express my opinions, even if others disagree with me. | Express Myself | NO | 3.7 | 2 | 0 | 2 | 4 | 4 |
| 7. When an argument is over, I often wish I would have said what was really on my mind. | Express Myself | YES | 2.3 | 2 | 0 | 3 | 1 | 6 |
| 8. I tend to just go along with what everyone else wants, instead of stating my own thoughts. | Express Myself | YES | 2.7 | 1 | 1 | 4 | 5 | 1 |
| 9. I sometimes avoid asking questions for fear of sounding stupid. | Express Myself | YES | 1.7 | 1 | 0 | 1 | 2 | 8 |
| 10. I tend to bottle up my emotions rather than talk about my feelings. | Express Myself | YES | 2.5 | 1 | 0 | 4 | 6 | 1 |
| 11. If I disagree with my teacher, I talk to him or her about it. | Express Myself | NO | 2.8 | 2 | 4 | 3 | 0 | 3 |
| 12. If a person has borrowed money (or a game, clothes, or something else of value) and is overdue in returning it, I talk to the person about it. | Express Myself | NO | 3.8 | 2 | 0 | 2 | 3 | 5 |
| 13. I generally express how I feel. | Express Myself | NO | 3.8 | 1 | 0 | 2 | 6 | 3 |
| 14. If my food order is wrong, I will return it. | Express Myself | NO | 2.2 | 5 | 2 | 4 | 0 | 1 |
| 15. I tend to lose my temper and swear at people. | Respect Others | YES | 1.7 | 1 | 0 | 2 | 0 | 9 |
| 16. I tend to yell at people when I don't get my way. | Respect Others | YES | 6 | 0 | 0 | 0 | 0 | 0 |
| 17. I am careful to avoid hurting other people's feelings, even when I feel that I have been wronged. | Respect Others | NO | 0 | 0 | 0 | 0 | 0 | 0 |
| 18. I am very careful to avoid attacking someone's intelligence when I disagree with their ideas. | Respect Others | NO | 0 | 0 | 0 | 0 | 0 | 0 |
| 19. I appreciate other people's opinions, even if I disagree with them. | Respect Others | NO | 0 | 0 | 0 | 0 | 0 | 0 |
| 20. In discussions, I restate what others said to make sure I understood them correctly. | Respect Others | NO | 0 | 0 | 0 | 0 | 0 | 0 |
| 21. In discussions, I communicate that I am listening through body language (nodding my head, eye contact). | Respect Others | NO | 0 | 0 | 0 | 0 | 0 | 0 |
| 22. Even in an argument, I don't interrupt the other person. | Respect Others | NO | 0 | 0 | 0 | 0 | 0 | 0 |
| Total Average With Reverse Questions Flipped | 2.1 OR (27.5%) | |||||||
